Provider Demographics
NPI:1730862673
Name:MCCALLA-TRAVIS, DYOMARITHZ RAQUEL
Entity type:Individual
Prefix:MISS
First Name:DYOMARITHZ
Middle Name:RAQUEL
Last Name:MCCALLA-TRAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 HACKMATACK WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-1062
Mailing Address - Country:US
Mailing Address - Phone:832-407-8555
Mailing Address - Fax:
Practice Address - Street 1:11510 HACKMATACK WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-1062
Practice Address - Country:US
Practice Address - Phone:832-407-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145521041C0700X
171M00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor